Form VAT - XXVI [See rule 9(1)] APPLICATION FOR REFUND OF TAX UNDER SECTION 34(1) OF THE GOA VALUE ADDED TAX ACT, 2005(Act 9 of 2005) (1) Name and address of the applicant dealer(exporter)........... (3) Quarter/period during which sales are made and in respect of which the refund is claimed.................... (4) Amount of refund claimed...................... (5) Details of sales (a separate Annexure to be attached in the following proforma): (6) Details of purchases of goods made within the State against the Tax Invoices related to aforesaid sale of goods (a separate Annexure to be attached in the following proforma). (7) The return for aforesaid period in Form VAT - VIII and in Form I under the Central Sales Tax (Registration and Turnover) Rules, 1957 are filed separately. Sr. No. Sale Invoice Description of goods Quantity Sale price of goods Name and address of the purchaser Mode of dispatch with supporting documents Mode of Payment. No. Date (1) (2) (3) (4) (5) (6) (7) (8) (9) Sr. No. Dealer from whom goods purchased (Name & address) TIN Tax Invoice Description of goods No. Date (1) (2) (3) (4) (5) (6) Quantity Price of goods Tax Charged Purpose of purchase i.e. for use in manufacture or for resale. (7) (8) (9) (10) DECLARATION I , hereby, declare that the above particulars are true to the best of my knowledge and belief. Further, I declare that no application for refund in respect of the present claim has made earlier. Place: Date: Signature of the dealer or his authorised representative. Status.........
